Safe Prescribing


Prescribing errors contribute to one of the most common adverse events in health care.

The factors contributing to prescribing errors are extremely complex and include:

  1. Characteristics of the clinical environment,
  2. Prescribing culture,
  3. Workload, time, and support.

Prescribing is not about the isolated pharmacology but it requires contextualization with a patient.


Preventing Adverse Drug Reactions (ADR) 

Safe and rational prescribing and dispensing of drugs entails therapeutic reasoning and decision making, such as choosing the right drug for each individual patient. The occurrence of an ADR to previous treatment, as well as the individual patient’s risk factors should influence this choice. 

Considering the circumstances that may influence the occurrence of ADRs in a patient is the first and foremost essential step.  This implies developing knowledge of general risk factors such as:

  • increased incidence of ADRs in the elderly,
  • individual risk factors related to a certain drug or to a person’s medical condition, such as comorbidity and genetic factors,
  • Drug–drug interactions can be expected, when patients use concomitant medication, especially in polypharmacy,
  • Patients using herbal or other traditional medicines,
  • Food–drug interactions may influence drug absorption or drug metabolism; for example, grapefruit juice inhibits drugs metabolized by cytochrome P450 (CYP)-3A4 
Information on these risk factors is generally available in drug labelling, treatment guidelines and medical literature, which you must learn to use and interpret.

When asking patient about specific features of a drug reaction you have to include any known drug allergy for the patient, and if the patient has any previous history of drug allergy it is vital that you must obtain more details about this allergy including:
  • drug name; 
  • character; 
  • time-frame;
  • possible non-drug causes (eg the illness itself);
  • reactions to similar drugs;
  • any prior skin/allergy testing  
These questions may help to delineate allergic vs non-allergic and serious vs non-serious reactions.

Tully et. al. grouped causes medication error into active failures, error-provoking conditions, and latent conditions, demonstrating the myriad of interacting factors involved in the complexity of prescribing within the context of a patient and the clinical environment.

Prescribing is not about the final prescription but the underlying process.

The written or oral prescription of a therapy is where an error manifests itself in a detectable way; however, it is well acknowledged that the complex process of prescribing is, in fact, a high-risk activity within which there are numerous opportunities for inaccuracies and mistakes.

The underlying process of generating the prescription includes a thorough background of pharmacological and therapeutic knowledge and skill; the ability to understand and assess the evidence base, cost effectiveness, and harm– benefit argument; and the facilitative communication skills to discuss management plans for therapy, monitoring, and dosage adjustment with other health care professionals and the patient[2].

The WHO six-step model has been designed as a normative model for therapeutic reasoning and prescribing and is suggested to provide a robust six-step guide to the process of rational and safe prescribing.

A systematic approach advocated by the World Health Organization can help minimize poor-quality and erroneous prescribing. This six-step approach to prescribing suggests that the physician should:

  1. Evaluate and clearly define the patient's problem
  2. Specify the therapeutic objective
  3. Select the appropriate drug therapy
  4. Initiate therapy with appropriate details and consider non-pharmacologic therapies
  5. Give information, instructions, and warning
  6. Evaluate therapy regularly (e.g., monitor treatment results, consider discontinuation of the drug).

The competency framework illustrated developed by the Royal Pharmaceutical Society provides the elements on what good prescribing looks like. For further reading refer to https://www.rpharms.com/resources/frameworks/prescribers-competency-framework


Prescribing is not only about personal knowledge, skill, and attitude but it is a participative process.

Error disclosure, analysis, and learning have to be recognized as ways to prevent error. Patient safety has to be adopted as a shared responsibility of all members of the team, with team work supported via interpersonal communication, collaboration, coordination, seeking qualified assistance when needed, and accepting colleague supervision, knowledge, and expertise. The interactive role of medical, pharmacy, and nursing staff has been demonstrated to enhance safe and effective use of medicines.


[1] Tully MP, Ashcroft DM, Dornan T, Lewis PJ, Taylor D, Wass V. The causes of and factors associated with prescribing errors in hospital inpatients: a systematic review. Drug Saf. 2009;32(10):819–836.

[2] Aronson JK, Henderson G, Webb DJ, Rawlins MD. A prescription for better prescribing. Br J Clin Pharmacol. 2006;333(7566):459–460


Comments

Post a Comment

Popular posts from this blog

Good Quality Care and Promotion of Patient Safety

Image
Patient Safety Patient safety means "the absence of preventable harm to a patient during the process of health care." In includes issues such as the prevention of hospital-acquired infections, surgical safety, medication errors, falls and accidents in hospital. Patient safety is a key aspect of patient-centered care and is tied to the patient experience and health outcomes. Protecting patients from harm is one of the most important things health professionals can do to their patients. Healthcare professionals should also stay attentive to procedure protocol, another key aspect to delivering a quality patient experience. Healthcare professionals must ensure that both patient safety and patient experience are top priority. Patients cannot have a positive experience without safety. Promoting family and caregiver engagement can likewise support patient safety by adding yet another set of eyes looking for inaccuracies in patient care. Patient safety practices have been defined as
Read more

Time Management and Organized Decision-Making

Image
Keeping up work–life balance as a doctor requires figuring out how to improve productivity and successfully deal with the constrained asset of accessible time. In fact, pressures on doctors have as of late expanded, halfway because of changes in doctor repayment what's more, a lessening in the accessibility of financing to help insightful and persistent focused attempts. Doctors as of now deal with a developing number of progressively complex patients in less time, manage a bigger volume of regulatory desk work, and are all the more effectively available by means of email, pagers, cell phones and other innovative propels, all components adding to high paces of expert burnout. Why should practitioners care? Poor time management means patients are kept waiting, you get stressed, your work becomes less enjoyable, stress can build, you lose your sense of humour and you lose valuable time for family, exercise and sleep. Effective time management can: increase productivity help deliver
Read more